Open Fractures

Question 1

compound fracture definition

Answer 1

archaic term for open fracture

Question 2

next step if suspect vascular compromise of an extremity

Answer 2

ankle brachial indices

Question 3

normal abi ratio

Answer 3

> 0.9

Question 4

general principles for radiographic evaluation of open fractures (2)

Answer 4

at least two orthogonal views, include joint above and below

Question 5

consider ct especially if _____

Answer 5

intra-articular involvement suspected

Question 6

gustilo and anderson type 1 (2)

Answer 6

clean skin opening < 1 cm, simple transverse or short oblique fractures

Question 7

gustilo and anderson type 2 (3)

Answer 7

laceration > 1 cm with extensive soft tissue damage, minimal-to-moderate crushing component, fracture with minimal comminution

Question 8

compartment measurements concerning for compartment syndrome (2)

Answer 8

> 30 mmHg or within 30 mmHg of diastolic plood pressure

Question 9

late finding in compartment syndrome

Answer 9

absence of distal pulses

Question 10

gustilo and anderson type 3 (2)

Answer 10

extensive soft tissue damage (usually > 10 cm long), often high-energy injury with a severe crushing component

Question 11

gustilo and anderson type 3a (1)

Answer 11

usually adequate soft tissue coverage of bone

Question 12

gustilo and anderson type 3b (1)

Answer 12

usually requires some soft tissue graft

Question 13

gustilo and anderson type 3c (1)

Answer 13

vascular injury along with need for soft tissue graft reconstruction

Question 14

markers for contamination in open fractures (3)

Answer 14

exposure to environmental factors, gross contamination on inspection, delay in treatment > 12 hours

Question 15

signs of high-energy mechanism (6)

Answer 15

segmental fx, bone loss, compartment syndrome, crush mechanism, extensive degloving, requires flap coverage

Question 16

tscherne open fracture grade 1 (3)

Answer 16

small puncture wound (no contusion), negligible bacterial contamination, low-energy mechanism of fracture

Question 17

tscherne open fracture grade 2 (4)

Answer 17

small laceration, skin and soft tissue contusions, moderate bacterial contamination, variable mechanisms of injury

Question 18

tscherne open fracture grade 3 (3)

Answer 18

large laceration with heavy bacterial contamination, extensive soft tissue damage, frequent associated arterial or neural injury

Question 19

tscherne open fracture grade 4 (2)

Answer 19

incomplete or complete amputation with variable prognosis based on location and nature of injury

Question 20

tscherne closed fracture grade 0 (2)

Answer 20

injury from indirect forces with negligible soft tissue damage

Question 21

tscherne closed fracture grade 1 (2)

Answer 21

closed fracture caused by low-to-moderate energy mechanisms, with superficial abrasions or contusions of soft tissues overlying the fracture

Question 22

tscherne closed fracture grade 2 (4)

Answer 22

closed fracture with significant muscle contusion, possible deep contaminated skin abrasions, associated with moderate-to-severe energy mechanisms and skeletal injury, high risk for compartment syndrome

Question 23

tscherne closed fracture grade 3 (3)

Answer 23

extensive crushing of soft tissues, subcutaneous degloving or avulsion, arterial disruption or established compartment syndrome

Question 24

how to treat hemorrhaging in open fractures

Answer 24

direct pressure

Question 25

temporizing measure for soft tissue wounds

Answer 25

moist sterile dressing

Question 26

only early intervention that has been shown to diminish the incidence of infection in open fractures

Answer 26

intravenous antibiotics

Question 27

important operative interventions before definitive fixation of open fractures (3)

Answer 27

wound exploration, irrigation, and debridement

Question 28

when should irrigation and debridement definitely not occur in the emergency room

Answer 28

when immediate operative intervention is planned

Question 29

what to do if surgical delay of >24 hours anticipated for open fractures

Answer 29

gentle irrigation with normal saline and removal of obvious foreign bodies that are easily accessible

Question 30

what should be done in the emergency room with bone fragments observed in the wound of an open fracture

Answer 30

nothing!

Question 31

antibiotic coverage for type 1 and 2 open fractures

Answer 31

first-generation cephalosporin

Question 32

examples of first-generation cephalosporins (3)

Answer 32

cefazolin/ancef, cefalexin/keflex, cefadroxil/duricef

Question 33

antibiotic coverage for type 3 open fractures

Answer 33

add an aminoglycoside

Question 34

examples of aminoglycosides (2)

Answer 34

gentamicin, streptomycin

Question 35

antibiotic coverage for open fractures associated with farm injuries (3)

Answer 35

add penicillin and an aminoglycoside

Question 36

how to extend the wound intraoperatively for adequate irrigation and debridement

Answer 36

proximally and distally in line with the extremity

Question 37

factors of muscle viability (4 c’s)

Answer 37

color beefy red, firm consistency, capacity to bleed, contractility to forceps pinch or low cautery setting

Question 38

which osseous fragments can be discarded

Answer 38

devoid of soft tissue

Question 39

which part of the wound is closed in irrigation and debridement of an open fracture

Answer 39

surgically extended part

Question 40

open fracture wound dressing (4)

Answer 40

saline-soaked gauze, synthetic dressing, vac sponge, or antibiotic bead pouch

Question 41

type of wound closure for open fractures

Answer 41

delayed primary or secondary

Question 42

treatment of road tar and oil in open fracture wounds

Answer 42

emulsifants (bisacodyl

Question 43

iss score necessitating limb amputation in gustilo grade 3 inuuries

Answer 43

> 20

Question 44

open fracture complications (2)

Answer 44

infection, missed compartment syndrome